Oncologist

An oncologist is a doctor who specializes in the diagnosis and treatment of cancer. Once diagnosed, the oncologist’s role is to explain and stage the patient’s disease, discuss various treatment options, recommend the best course of treatment, provide optimal care, and improve the patient’s quality of life, both through curative therapy and palliative care for pain and symptoms. .

There are different types of cancers that affect different parts of the body, such as breasts, prostate, lungs, blood cells (leukemia) or other organs, in principle, cancer can affect any organ, they behave differently, are different classes and cell types respond differently to treatment and each disease has a different set of effective treatment regimens.

This requires the need for different specialties of oncologists. However, cancer care is a multidisciplinary approach and consists of a team of specialists who assist in the care of the patient.

Types of oncologists

A radiation oncologist is a specialist who treats cancer using radiation therapy.

Surgical oncologist – this industry includes surgeons who treat cancer surgically, remove tumors. Because tumors are highly vascular (they have a rich blood supply), oncology surgeons need specialized skills to excel in oncology.

A chemotherapist is an oncologist who treats cancer with chemotherapy drugs.

Interventional oncologist are interventional radiologists who specialize in minimally invasive tumor therapy.

A gynecologist-oncologist is a doctor who treats oncology of the female reproductive organs.

Pediatric oncologist – an oncologist who deals only with childhood cancer of any form and localization, pediatric oncologists are still divided into narrower specialties, for example, a pediatric oncologist surgeon, or a pediatric hemato-oncologist.

Neurooncologist – treats tumor diseases of the brain and spinal cord.

A hemato-oncologist is a doctor who specializes in tumors of the blood and the hematopoietic system.

Urologist-oncologist – deals with cancer of the urogenital tract, such as the prostate gland and others, such as a dermatologist-oncologist, a mammologist-oncologist, an endocrinologist-oncologist, a proctologist-oncologist, a thoracic oncologist.

Diseases treated by an oncologist

An oncologist deals with the treatment of oncological diseases, which include malignant and benign tumors. There are a huge number of them, depending on the organ that is affected and the type of tumor cells. The most common are: stomach cancer, melanoma, lung cancer, liver carcinoma, hemangioma, leukemia, lymphoma, sarcoma, ovarian cancer, breast cancer, uterine fibromyoma and many others.

Symptoms that should see an oncologist

Oncological pathology can affect absolutely any organ of the human body, and depending on this, the symptoms can be very different. But there are several symptoms that are not pathognomonic, but make doctors think about the possibility that the patient has some kind of this dangerous disease, and all people should be aware of their existence and be alert, these include:

• general weakness;
• fatigue;
• significant weight loss in a short time;
• unexplained anemia;
• fever of unknown origin and others.

Diagnostics in the practice of an oncologist

The most important diagnostic tool in the practice of an oncologist is the clinical history of the patient. That is, his complaints, general condition, history of oncological diseases in the family.

One of the main diagnostic methods in oncology, without which, at present, it is impossible to confirm the diagnosis of cancer, is such a study as a biopsy – the removal of pieces of tumor tissue and its examination under a microscope.

Other informative diagnostic tools in oncology include:

• endoscopy of the gastrointestinal tract;
• x-ray examination;
• CT scan;
• MRI scan;
• ultrasonography;
• scintigraphy;
• single photon emission tomography;
• positron emission tomography, etc.

A very important point in the early diagnosis of oncological diseases is their screening in a population that has risk factors for a certain type of oncopathology.

Tasks of an oncologist

Tasks performed by an oncologist:

1. Monitor relapse and remission. After completing the initial therapy, which is aimed at getting rid of the tumor, oncologists monitor the patient to detect relapse, or remission. The first means the recurrence or return of cancer, and the state of remission means the absence and cure of cancer.
2. Palliative care. The oncologist is also responsible for palliative or symptomatic care in patients with terminal malignancies. This and other questions of treatment choice have several ethical issues, including autonomy and patient choice, which the oncologist needs to be concerned about.
3. Cancer prevention. Oncology and oncology research includes screening the general population for cancers and screening relatives of patients for types of cancer that are believed to be hereditary. For example, in breast cancer population screening by regular mammography and family screening by genetic analysis of the BRCA1 and BRCA2 genes.
4. progress in oncology. A huge amount of research is being done in all areas of oncology, from cancer biology to chemotherapy, as well as optimal palliative care and pain relief. This makes oncology a constantly changing and evolving field.

Therapies

Oncologists in their practice, depending on their specialization, use the surgical method, the method of radiation therapy and chemotherapy. Cancer therapy depends on many factors. Some of them:

• type of cancer;
• cancer stage;
• cancer aggressiveness;
• the general condition of the patient;
• acceptability of the patient’s treatment.

Surgical method

The primary and oldest treatment for cancer is surgery, and several special surgical techniques are used. Surgery is also used in diagnosis and diagnosis to determine the extent and stage of the disease.

Surgical therapy can be of two types: preventive surgery and curative surgery. A patient may choose to have surgery to prevent a particular cancer if they have a predisposition to that disease. Prophylactic surgery consists of removing tissue that is not cancerous, but that could become cancerous. A common example is the prophylactic or preventive removal of the breasts in women with a mutation in the BRCA gene, which increases the risk of breast cancer.

Curative surgery involves removal of the tumor and is often combined with chemotherapy or radiation therapy to achieve a cure.

There is another type of surgery called palliative surgery. Palliative surgery is not done to treat cancer, but is used to treat complications of a progressive disease. This type of surgery can also be used to remove the bulk of the tumor. For example, palliative surgery can destroy tumors that block organ function. Palliative surgery is also used to treat pain that is difficult to control with medication.

Radiation therapy

Uses X-rays to kill cells. All body cells have a cell cycle. The cell grows from G0, G1, S, G2 and M. Radiation is most effective on cells that are in the stages of division and less effective for cells in the “resting” phase of G0. Radiation therapy aims to stop cancer cells from multiplying by killing them and destroying the tumor.

However, radiation therapy is not selective and can affect the rapid division of surrounding healthy cells. This includes the cells that line the mouth and hair cells are also often destroyed, leading to mucositis (sores in the mouth or mouth) and baldness (hair loss), respectively.

Other dividing cells, such as blood cells, are also destroyed by radiation, resulting in low white blood cell counts and susceptibility to infections, as well as low red blood cell counts, leading to anemia. There may also be a low platelet count, leading to a tendency to bleed.

During radiotherapy, medications such as radioprotectors or radiosensitizers are often used in combination therapy to reduce damage to healthy tissue and improve outcomes.

There is radiation therapy using external beam radiation, which involves visiting the doctor’s office every day of the week to receive a dose of radiation. Hyperfractionated radiotherapy provides small doses of radiation every 4 to 6 hours, 2 or 3 times a day. This applies to tumors with a rapid division process. Another form of radiation therapy is internal radiation, in which an implanted radioactive material is used to deliver a continuous dose of radiation over several days. Internal radiation is also called brachytherapy.

Chemotherapy

This is a treatment that uses drugs to kill cancer cells. Chemotherapy drugs can be administered as a tablet, injection, or intravenous infusion. There are several hundred chemotherapy drugs that are used alone or in combination with other drugs to treat cancer.

Like radiation therapy, chemotherapy aims to rapidly divide cells, usually to disrupt cell division. Chemotherapy can be used after surgery or radiation to kill any remaining cancer cells that have been missed by other forms of therapy.

There are various forms of chemotherapy. Many types of drugs are used as anticancer therapies, including alkylating agents, antimetabolites, and enzyme inhibitors.

Chemotherapy consists of three stages:

1. Induction is the initial intensive phase of chemotherapy.
2. Consolidation – during this phase, the therapy stabilizes.
3. Maintenance therapy – this stage can be continued for longer periods.

The number of cycles in each course may vary. Chemotherapy is given in cycles, with a rest period between cycles, and cycles can last from 3 months to 3 years, depending on a number of factors. The duration of cancer chemotherapy depends on the type of cancer, the type of drugs, and responses such as eradication or progression of the tumor.

Chemotherapy is classified as adjuvant or neoadjuvant if given before or after surgery, respectively. There are several new approaches to chemotherapy: Hormone therapy is used for several hormone-dependent cancers such as breast cancer, prostate cancer, etc. Angiogenesis therapy is used to stop new blood vessels from forming in tumors and literally starve them. Photodynamic therapy combines light and a photosensitizing agent, the drug accumulates in the diseased organ, when exposed to laser light, the chemicals derived from the drug kill cancer cells. Gene therapy aims to change the genetic makeup of a tumor or organism by inserting the desired gene into the DNA of cells that have been removed from the patient. These removed cells are reprogrammed and inserted into the patient’s body. In some cases, the reprogrammed cells strengthen the patient’s immune system. In some cases, the reprogrammed cells help other chemotherapy drugs work.

Bone marrow transplantation and stem cell transplantation are often the first line of treatment for blood cancers such as leukemias and lymphomas and are used as experimental treatments for other cancers.

If the disease is detected early, many types of cancer can be effectively treated. About 50% of cancers can be cured with radical treatment. For pediatric patients, this number is much higher. Despite this, a large number of cancer patients die every year from the disease and its complications.

Palliative care

This method consists in alleviating the symptoms that occur in patients in the final stages of cancer. Palliative care provides symptomatic relief for the patient, as well as psychosocial and supportive care for the patient and family members. Palliative care is useful in patients who are in the advanced stages of cancer and have a very low chance of being cured, or when they are facing terminal disease.

These end phases of cancer are often burdened with the need for emotional, spiritual, social and economic support. Palliative care is an urgent humanitarian need around the world for people with cancer and other chronic life-threatening diseases, especially in the end stages.

It is said that people who successfully cope with cancer treatment are in remission. However, even after successful therapy and a long life in remission, the risk of cancer recurrence remains. Thus, cancer patients need appropriate therapy and follow-up for cancer detection. Cancer is often considered incurable, but thanks to advances in diagnostic methods that allow for early diagnosis and detection of cancer, and advances in cancer treatments, there are a huge number of patients who lead a busy life after cancer.

The work of an oncologist is very difficult both physically and mentally. During his medical practice, the oncologist faces numerous and very important ethical issues. For example, the question of the amount of information about the stage of the patient’s disease that needs to be provided to him. It is also an ethical problem to test new methods of treating cancer patients. Problems with the end of life, euthanasia also greatly affect the emotional state of the doctor. Therefore, oncology is one of the most complex branches of medicine, and the people who deal with it, oncologists, deserve great respect for their hard and courageous work.